Individual
DESTANY SHIANNE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 N 3RD ST, LEESVILLE, LA 71446-4014
(337) 239-3336
Mailing address
112 N 3RD ST, LEESVILLE, LA 71446-4014
(337) 239-3336
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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